Clinical Implication of Energy Loss Coefficient in Patients With Severe Aortic Stenosis Diagnosed by Doppler Echocardiography
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Key result
In patients with severe aortic stenosis diagnosed by Doppler echocardiography, an Energy Loss Coefficient >1.0 cm2 was associated with a significantly lower incidence of symptoms (14% vs 81%, p=0.002).
Why the study?
Does the energy loss coefficient (ELCo) improve the assessment of aortic stenosis severity compared to Doppler effective orifice area (EOADop) in patients with severe AS?
Population
33 patients with severe aortic stenosis by Doppler examination referred to the cardiac catheterization…
Comparison
Assessment of aortic stenosis severity using the… vs Assessment of aortic stenosis severity using…
Design
Cross-sectional, Cardiac catheterization was performed by 2 experienced…
Authors
Discussion
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Implication
ELCo may aid symptom risk stratification in severe AS; leaves open whether it improves grading over EOADop pending prospective validation.
Study Design
Type
Observational (n=33)
Multicenter
No
Structured PICO
Does the energy loss coefficient (ELCo) improve the assessment of aortic stenosis severity compared to Doppler effective orifice area (EOADop) in patients with severe AS?
P
Population
33 patients with severe aortic stenosis (AS) by Doppler examination (EOADop ≤1.0 cm2) referred to the cardiac catheterization laboratory. Mean age 71±8 years, 20 females, 13 males. Excluded: atrial fibrillation, other moderate to severe valvular heart diseases, dialysis, and systolic left ventricular dysfunction (LVEF <40%).
I
Intervention
Assessment of aortic stenosis severity using the Doppler-derived energy loss coefficient (ELCo)
C
Comparator
Assessment of aortic stenosis severity using Doppler-derived effective orifice area (EOADop) and catheter-derived effective orifice area (EOAcath)
O
Outcome
Concordance in severity of aortic stenosis between EOAcath and ELCo compared with EOAcath and EOADopsurrogate
Main Result
Absolute Event Rate: 14% vs 81%
p-value: p=0.002
The energy loss coefficient (ELCo) provides a more accurate assessment of aortic stenosis severity than standard Doppler effective orifice area by accounting for pressure recovery, reclassifying 21% of 'severe' AS patients to moderate AS.
Limitations
- Pressure recovery was not directly measured by invasive technique
- Distal pressure measurements were not obtained at sites where pressure had recovered to the fullest extent
- Small, observational series
Cite This Study
Kume et al. (2008) conducted an observational in Severe aortic stenosis (n=33). Energy Loss Coefficient (ELCo) > 1.0 cm2 vs. Energy Loss Coefficient (ELCo) ≤ 1.0 cm2 was evaluated on Incidence of symptoms related to aortic stenosis (dyspnea, angina pectoris, syncope) (p=0.002). In patients with severe aortic stenosis diagnosed by Doppler echocardiography, an Energy Loss Coefficient >1.0 cm2 was associated with a significantly lower incidence of symptoms (14% vs 81%, p=0.002).
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